Vehicular Trauma Syndrome

A new syndrome related to vehicular trauma is identified.

Posted Apr 14, 2017

I want to introduce a new syndrome which I call Vehicular Trauma Syndrome or VTS. From my clinical practice which specializes in treating people who have survived serious vehicular accidents of one kind or another, I have come to recognize a constellation of psychological and physical symptoms specific to these kinds of accidents. There are also characteristic stages of recovery which I will briefly describe.

I believe VTS is new because I have not found it described as such anywhere, although parts of it are broken up into various diagnoses we commonly use. My practice in metro Detroit, the Motor City, sees a steady flow of newly minted auto accident victim’s courtesy of no apparent shortage of distracted, drunk, drugged, fatigued, speeding and otherwise impaired drivers who cause the accidents.

Because the symptoms are fairly consistent and involve far more than those included under the diagnosis of post-traumatic stress disorder, a separate diagnosis may be helpful both from clinical and research perspectives. VTS is a sort of stew comprised of elements of PTSD, TBI, Adjustment Disorder with Mixed Anxiety and Depressed Mood, Post-concussive Syndrome, Cognitive Disorder, Pain Disorder related to Medical and Psychological factors, and emotional reactions to a host of physical injuries. By cognitive we mean such daily mental functions as thinking, memory, problem-solving, speech, reasoning, judgment, understanding and decision making

Emotionally, common elements include fearfulness, uncontrolled crying spells, sleep disturbance, fear of being crazy, symptoms of pain and tension, not feeling like oneself, having difficulty concentrating and focusing, and a host of visual and auditory symptoms. Medication side-effects can play a factor which needs to be constantly monitored by the prescribing professionals. 

There is much more that can be said about VTS; for now, let’s turn to a brief description of the stages of recovery I frequently observe.

Stage One

Stage one is the acute phase. The accident has just happened and your world is upside down. There is predominate confusion, fear, and shock. The physical and psychological injuries have not yet been fully identified. Definitive diagnoses may take weeks or months to determine based upon continued diagnostic studies and response to preliminary treatment efforts. 

Psychologically, there is disequilibrium and difficulty coping with fear, uncertainty and an onslaught of PTSD and other emotional and cognitive symptoms. Difficulty interacting with others is common as you attempt to gain some footing in dealing with what seems to be a never-ending series of distressing and painful experiences. There is confusion about which professional providers are needed to facilitate treatment and recovery. 

Sometimes you are unable to keep food or medication down, or lash out at others in anger without provocation. You are chronically fatigued due to sleep disturbance resulting from pain, anxiety, nightmares and worry. There is a prevailing sense that something is wrong; you are not feeling like yourself but you are not being able to identify or put a name to it. Sometimes there is uncontrolled laughing or crying which may be the result of brain trauma—clinically referred to as Pseudobulbar Affect (PBA). Your vision and hearing may be compromised. You may have light and sound sensitivity, or ringing in the ears. You may also have severe headaches that last for hours or days. And there may be constant pains in different areas of your body. Collectively, these symptoms are very distressing and can seem overwhelmingto say the least. And, because vehicles are omnipresent, the fear stimulus cannot be easily avoided which can lead to problems with generalized anxiety which is difficult to manage. Even traveling to and from medical appointments is highly anxiety provoking.

Stage Two

In stage two, you know much of what is wrong medically and psychologically, and many of the appropriate treatments have begun with some degree of success. Often you continue to struggle with significant neuro-fatigue, and have many days of still feeling overwhelmed, fearful and depressed. You have a team of professionals you can trust who you work with on an intense, regular basis. You may have many treatment appointments each week which can sometimes feel overwhelming in itself. You may be disabled from work, or if you are still working, you are struggling to stay focused due to continued pain, memory problems, fatigue and other psychological symptoms such as anxiety.

Stage Three

In stage three, you want more independence, having had to forfeit much of it in stages one and two. You are seeing progress with respect to chronic symptoms that have developed, maybe some of them have resolved and there is starting to be some feeling a light at the end of the tunnel. You have days when you accept your new normal, with its limitations and struggles, and other days when there is much continued grief and depression. You start to reclaim some parts of your pre-injury identity step-by-step.

They say there is nothing new under the sun, but I believe it makes sense to conceptualize a new, distinct syndrome as it relates to vehicular trauma. VTS represents a complex web of interconnecting conditions whose elements must be carefully examined, evaluated and repaired. Each element requires attention, resolution, and healing which informed and committed psychotherapy can facilitate.